The U.S. Donald Trump administration has proposed a major change to Native Americans health program, by dismissing their sovereignty and classifying them as a race, under which the Indigenous communities will be included in Medicaid work rules, a move which could further marginalize them and pose a serious threat to their health access.

So far, three U.S. states, Arkansas, Kentucky, and Indiana have taken the lead to institute work-requirements which would make them eligible for Medicaid, paving the way for other states to follow the suit. Under the Medicaid requirements, the participants will have to work between 20 to 80 hours each month in order to continue receiving the health insurance.

The tribal leaders are contesting the U.S. administration's stance, which they say, violates the centuries-old protection treaties signed by President George Washington, and reaffirmed by the Clinton, George W. Bush and Obama administrations, respectively.

"The United States has a legal responsibility to provide health care to Native Americans," Mary Smith, who was acting head of the Indian Health Service during the Obama administration and is a member of the Cherokee Nation, told Politico. "It's the largest prepaid health system in the world - they've paid through land and massacres - and now you're going to take away health care and add a work requirement?"

Seema Verma, administrator with the Centers for Medicare and Medicaid Services confirmed the news in January, stating the U.S. Human and Health Services, HHS, contends that tribes are a race as opposed to a separate sovereign government, and thus won't be exempt from the Medicaid work rules, Indian Country Media Network, reported.

A review of administration lawyers, told Politico, that, "HHS believes that such an exemption would raise constitutional and federal civil rights law concerns."

The new policy on Medicaid work requirements "does not honor the duty of the federal government to uphold the government-to-government relationship and recognize the political status enshrined in the Constitution, treaties, federal statutes, and other federal laws," Jacqueline Pata, executive director of the National Congress of American Indians, told the Indian Country Media Network. "Our political relationship is not based upon race."

The tribal leaders and activists have also raised concern that attack on the health services is just one of the many changes which Trump administration is working on as it may look to stifle other welfare programs which could impact the Indigenous communities nationwide.